Adoption & Foster Assistance Request

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For Hillcrest Church Attendees

Hillcrest Church will grant a reimbursement up to $1000 for Foster Care Licensing costs, with receipts.

This is to help with things such as home modifications, required accessories, beds, smoke detectors, fencing, etc.

Hillcrest Church will grant up to $3000 per child toward U.S. Adoption costs, and up to $4000 for International Adoption costs.

All grants are limited to one financial assistance grant per year.

Applicant Name(s): *

Amount Requested: *

Household Members(s): *

Address: *

Phone: *

Email Address: *

Have you adopted before? *

Yes

What has motivated you to adopt? *

Agency and/or Attorney you are working with: *

Agency contact information: *

Is your home study completed (completion is mandatory before funds are awarded)? *

Yes

What fees/expenses do you anticipate in this adoption? *

International adoption funds are needed for: *

Travel

Agency Expenses

Other

N/A

When do you expect to have the child In your care? *

How long have you attended Hillcrest Church? *

If you have an adoption support group, provide the name and contact information: *

Do you have any significant financial debt other than home and auto (if yes, list below)? *

Have you requested/received assistance from any other church and/or agency regarding adoption expense assistance (if yes, please name the amounts and dates of the grants/assistance received)? *

Please list any additional means of financial support you intend to use toward this adoption: *

Addition Information:

Once your application has been reviewed you will be asked to provide two reference letters and information to contact the references (one from your Pastor and one from a non family member).
Verification of your completed and approved home study (this can be the signature page with documentation that it has been approved, or a letter/email from the agency/attorney verifying the approved home study.

Thank you for your application. Hillcrest Church Adoption Support Committee reserves the right to contact references and agencies listed above for verification of information. Your signature states you understand this agreement and release Hillcrest Church to use your name in these inquiries. You will be notified shortly regarding the status of your request.

Your Signature(s) - your typed signature(s) below is your authorized signature for applications completed online: *

Date: *

YYYY

For Committee Use Only

Date Application Received: Date Applicant(s) Notified:

Amount Awarded:

Committee Reviewer's Initials:

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